October 2008




Surgery in 3-D

by Vanessa Caceres EyeWorld Contributing Editor



Three-dimensional system touted for use in ORs and in teaching

TrueVision Systems’ Microsurgery Teaching System Source: Robert Reali

Dr. Weinstock using the Microsurgery Teaching System

Dr. McDonald using the Microsurgery Teaching System Source for both: Robert Reali

The next surgical film you watch may come to life in a whole new way. At least that’s the goal of the 3-D surgical system developed by TrueVision Systems (Santa Barbara, Calif.), which wants to bring its system to the forefront at meetings and in operating rooms.

Their Microsurgery Teaching System, which was introduced in 2006, has been slowly gaining ground in ophthalmology, neurosurgery, ENT, and other specialties, said Robert Reali, vice president of marketing and operations, TrueVision Systems.

“In ophthalmology, it’s really taken off. The image lends itself to ophthalmology,” he said.

The system offers a 3-D high-definition attachment for microscopes. It uses cameras in place of the microscope’s eye pieces. The image is sent to a computer, which then projects onto a plasma screen. Viewers need to wear special polarized glasses to see the 3-D image.

TrueVision has sold over 12 systems so far this year, Mr. Reali said. Each system costs $60,000 plus an additional $30,000 for the recording system. TrueVision has been eager to present its system at medical conferences. TrueVision’s system was first used at an educational event earlier this year held during the annual clinical meeting of the Kansas City (Mo.) Society of Ophthalmology and Otolaryngology, said John C. Hagan III, M.D., F.A.C.S., Kansas City, Mo.

“Many made the comment that it looked and felt exactly like being in surgery,” Dr. Hagan said.

TrueVision has also exhibited or shown 3-D videos at other meetings, including this year’s American Society of Cataract & Refractive Surgery symposium in Chicago.

How it works in the OR

Surgeons who have had the chance to use the system in their OR say it has a few advantages.

Because the surgeon looks at a screen versus a microscope, his body position is ergonomically better, said J.E. “Jay” McDonald II, M.D., Fayetteville, Ark., who has used the system for more than a year and a half.

“At present, I think most physicians would prefer to do the actual surgery with the operating microscope, but in the future, it might be possible to do the surgery with the heads-up display. That would be easier on the surgeon’s back and neck,” Dr. Hagan said.

Robert J. Weinstock, M.D., associate professor of ophthalmology, University of South Florida, St. Petersburg, already does many of his surgeries using the system in the heads-up position. He began using the 3-D technology for pterygiums, lid tumors, and lid lesions to get comfortable with the system. He then progressed to use it for incisions, capsulorhexes, and eventually, other components of surgery. He uses the TrueVision system in one of his three ORs.

Another advantage of the system is that everyone in the room—scrub nurses, circulating nurses, and observers—can witness on the screen what is happening and anticipate the surgeon’s needs, Dr. Hagan said.

“It puts the OR team on the same page. I call it IMAX for the OR,” Mr. Reali said.


There are still some improvements to be made to the system, said surgeons who otherwise applaud its use.

Some say that the image seen through the 3-D system could be crisper in about 10% of cases. The newest camera available through the system may help remedy this problem, Mr. Reali said. It’s one third the size of the original camera and has increased image resolution by 42%.

Surgeons would also like to see the system develop so they can manipulate more information on the screen.

“They could put depth scales on the side of the screen, or the screen could indicate phaco power and aspiration rate,” Dr. Weinstock said. It would also be helpful to have an area where surgeons could write notes that appear on the screen, he said. The goal is to also put the system to use at teaching institutions, Mr. Reali said. Although the system seems to have a “wow” effect, Oliver Findl, M.D., consultant ophthalmic surgeon, Moorfields Eye Hospital, London, and associate professor of ophthalmology, Medical University of Vienna, Austria, wonders how easy it would be to use the system in a teaching setting. He said it may be difficult for newer surgeons to understand the three-dimensional images anatomically in contrast with eye animation, which teachers can make more complex as necessary. “That’s where animation comes in, where you can open the eye, color code, and work with texture and highlighting,” Dr. Findl said. “I’m not sure if didactically [the 3-D system] would be helpful.” Still, “It may have applications in medical teaching such as surgical anatomy dissections and residents’ eye surgery,” Dr. Hagan said. “There may be other uses outside of medicine such as entertainment or industrial manufacturing that will expand demand for the system.”

Editors’ note: Mr. Reali is an employee of TrueVision (Santa Barbara, Calif.). Dr. Hagan has no financial interests related to his comments. Drs. McDonald and Weinstock have financial interests with TrueVision. Dr. Findl has no financial interests related to his comments.

Contact Information

Findl: oliver.findl@meduniwien.ac.at

Hagan: 816-478-1230, jhagan@bizkc.rr.com

McDonald: 479-521-2555, mcdonaldje@mcdonaldeye.com

Reali: 805-963-9700, Robert.Reali@truevisionsys.com

Weinstock: 727-585-6644, rjwweinstock@yahoo.com

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